本文關鍵詞： 廢用綜合征 維西醫(yī)結合康復護理干預 關節(jié)活動度 便秘　出處：《新疆醫(yī)科大學》2017年碩士論文　論文類型：學位論文

【摘要】：目的:選取在養(yǎng)老福利院療養(yǎng)的日常生活活動能力FIM量表評分低于54分長期臥床廢用綜合征患者,通過調(diào)查分析廢用綜合征患者的一般情況,并采用維西醫(yī)結合康復護理干預對長期臥床廢用綜合征關節(jié)攣縮的患者進行干預,探討其對肌力、肌張力、關節(jié)活動度、運動功能、30秒站立堅持時間、日常生活活動能力、生活質(zhì)量、便秘等的療效。方法:選擇長期居住在烏魯木齊市兩所養(yǎng)老福利院,因各種原因造成的長期臥床,低運動而發(fā)生的肌肉萎縮及關節(jié)攣縮的日常生活活動能力得分采用FIM量表評分低于54分的廢用綜合征患者作為研究對象,對其進行廢用綜合征一般情況、肌力、肌張力、關節(jié)活動度、30s站立堅持時間、運動功能、日常生活活動能力等基線情況進行問卷調(diào)查并分析。將80例廢用綜合征患者按照隨機數(shù)字法分為實驗組40例與對照組40例,實驗組進行維西醫(yī)結合康復護理干預,對照組進行常規(guī)的診療及康復護理,并對干預前、干預4周后,追蹤期結束8周后的指標(肌力及肌張力、關節(jié)活動度、30s站立堅持時間、運動功能、日常生活活動能力、生活質(zhì)量等的得分)進行療效評價。結果:1.基線結果:(1)廢用綜合征患者的基線資料:80例廢用綜合征患者的平均年齡為(69.25±7.80)歲,其中男性為50例,女性為30例;自理程度:完全不自理者33例,部分不自理者47例。(2)實驗組和對照組患者在干預前的基線資料的比較,兩組患者性別、年齡、廢用綜合征病程等一般情況經(jīng)統(tǒng)計學處理,差異無統(tǒng)計學意義(P0.05),具有可比性。2.干預前后實驗組和對照組的變化:(1)實驗組患者在肌力,肩關節(jié)、肘關節(jié)(屈)、腕關節(jié)、髖關節(jié)、膝關節(jié)(屈)、踝關節(jié)等關節(jié)活動度,運動功能,日常生活活動能力,30s站立堅持時間,生活質(zhì)量等得分在干預前、干預4周后、追蹤期結束8周后的比較,差異均具有統(tǒng)計學意義(P0.05)。實驗組肌張力在干預前、干預4周后、追蹤期結束8周后的得分的比較,差異無統(tǒng)計學意義(P0.05)。(2)對照組患者在肌力,肩關節(jié)、肘關節(jié)(屈)、腕關節(jié)關節(jié)活度,運動功能,日常生活活動能力等得分在干預前、干預4周后、追蹤期結束8周后的比較,差異有統(tǒng)計學意義(P0.05)外,其余的均無統(tǒng)計學意義(P0.05)。(3)干預前實驗組和對照組患者均有不同程度的便秘癥狀,用手微振動護理方法干預后,實驗組無一例出現(xiàn)便秘癥狀,對照組有17例(43.6%)出現(xiàn)便秘癥狀。兩組患者便秘發(fā)生率比較,差異有統(tǒng)計學意義(χ2=20.775,P0.05)。3.實驗組和對照組患者各指標的比較:(1)肌力和肌張力得分的比較:實驗組和對照組在干預前、干預4周后、追蹤期結束8周后的肌力得分的比較,干預前無統(tǒng)計學差異,干預4周后、追蹤期結束8周后肌力的比較,其差異具有統(tǒng)計學意義(P0.05),實驗組肌力的提高比對照組較好。實驗組和對照組在干預前、干預4周后、追蹤期結束8周后的肌張力得分的比較,除了追蹤期結束8周后的左上肢肌張力和右下肢肌張力得分的比較差異有統(tǒng)計學意義(P0.05)外,其余的均無統(tǒng)計學意義(P0.05)。實驗組和對照組在肌張力的改變沒有明顯差異。(2)肩關節(jié)、肘關節(jié)、腕關節(jié)關節(jié)活動度得分的比較:實驗組和對照組患者在干預前、干預4周后、追蹤期結束8周后關節(jié)活動度得分的比較,除了追蹤期結束8周后肩關節(jié)(屈、外展)關節(jié)活動度的比較差異有統(tǒng)計學意義(P0.05)外,其余的均無統(tǒng)計學意義(P0.05)。實驗組和對照組患者在肩關節(jié)、肘關節(jié)、腕關節(jié)活動度的變化不太明顯。(3)髖關節(jié)、膝關節(jié)、踝關節(jié)的關節(jié)活動度得分的比較:實驗組和對照組患者在干預前、干預4周后、追蹤期結束8周后關節(jié)活動度的比較,除了干預前髖關節(jié)、膝關節(jié)、踝關節(jié)關節(jié)活動度的比較差異無統(tǒng)計學意義(P0.05),實驗組和對照組患者在干預4周后、追蹤期結束8周后的髖關節(jié)(屈、伸、外展、內(nèi)收、內(nèi)旋、外旋),膝關節(jié)(屈、伸)踝關節(jié)(背屈、跖屈、內(nèi)翻、外翻)關節(jié)活動度的比較差異均有統(tǒng)計學意義(P0.05)。干預后髖關節(jié)、膝關節(jié)、踝關節(jié)關節(jié)活動度的改善,實驗組患者關節(jié)活動度明顯優(yōu)于對照組。(4)日常生活活動能力、生活質(zhì)量、30s站立堅持時間、運動功能得分的比較:實驗組和對照組在干預前、干預4周后、追蹤期結束8周后的運動功能、日常生活活動能力、生活質(zhì)量、30s站立堅持時間的比較,干預4周后的生活質(zhì)量、30s站立堅持時間和追蹤期結束8周后的運動功能、日常生活活動能力、生活質(zhì)量、30s站立堅持時間得分的比較差異有統(tǒng)計學意義(P0.05)外,其余無統(tǒng)計學意義(P0.05)。結果表明,在追蹤期結8周后,實驗組在日常生活活動能力、運動功能、生活質(zhì)量、30s站立堅持時間的得分的改善情況明顯高于對照組的得分。(5)干預前、干預4周后和追蹤期結束8周后,兩組排便次數(shù)的比較,差異有統(tǒng)計學意義(t=-1.537、15.275、18.458,P0.05)。隨著干預時間的推移,排便次數(shù)增加。實驗組緩解便秘的效果優(yōu)于對照組。結論:維西醫(yī)結合康復護理干預方法對廢用綜合征患者肌力,關節(jié)活動度,運動功能,日常生活活動能力,生活質(zhì)量,30s站立堅持時間,便秘等指標有明顯療效,日常生活逐漸趨向自理,可以解決自己最基本的日常生活活動。肌力,關節(jié)活動度和生活質(zhì)量得到明顯的提高,減輕便秘效果較好,并且治療效果可以維持較長時間,沒有復發(fā)及不良反應發(fā)生,安全、經(jīng)濟、方便、快速有效。維西醫(yī)結合康復護理方法可以讓廢用綜合征患者生活去向自理,提高患者的生活質(zhì)量,值得推廣到養(yǎng)老護理領域
[Abstract]:Objective: to select the score below 54 long-term bedridden patients with disuse syndrome in ADL FIM nursing old-age welfare institute, through the investigation and analysis of the general situation of disuse syndrome, and the use of medicine in Weixi rehabilitation nursing intervention intervention in bedridden disuse syndrome joint contracture patients, to explore the the muscle strength, muscle tension, joint activity, motor function, 30 seconds standing time to adhere to the quality of life, activities of daily living, and the effect of constipation. Methods: long-term residence in Urumqi City old-age welfare institute, bedridden due to a variety of causes, muscle atrophy and joint contracture and the occurrence of low motion ADL scores using FIM score less than 54 points of disuse syndrome patients as the research object, carries on the disuse syndrome in general, muscle strength, muscle tension, joint. Mobility, 30s standing time to adhere to motor function, analysis, questionnaire survey and ADL baseline. 80 patients with disuse syndrome were randomly divided into experimental group 40 cases and 40 cases in the control group, the experimental group were given rehabilitation nursing intervention combined with medicine control group Sulawesi, treatment and rehabilitation the routine nursing, and the intervention before and after 4 weeks of intervention, the follow-up period was 8 weeks after the end of the index (muscle strength and muscle tension, joint activity, 30s insisted on standing time, motor function, activities of daily living, quality of life score) for clinical evaluation. Results: 1. baseline results: (1) disuse syndrome: 80 cases of patients with baseline data of disuse syndrome patients for the average age (69.25 + 7.80) years old, including 50 cases of male, female 30 cases; degree of self-care: no self-care in 33 cases, 47 cases were not part of themselves. (2) the experimental group and the control group patients in the stem Comparison of baseline data pre of the two groups of patients with gender, age, duration of disuse syndrome in general statistically, there was no statistically significant difference (P0.05), with comparable changes in the experimental group and the control group before and after the intervention of.2.: (1) patients in the experimental group in muscle strength, shoulder joint, elbow joint (flexion), wrist, hip, knee, ankle joint (flexion) joint activity, motor function, activities of daily living, 30s standing time to adhere to the quality of life score, before intervention, after 4 weeks of intervention, the follow-up period was more than the end of 8 weeks, the differences were statistically significant (P0.05). The muscle tension of experimental group before intervention, after 4 weeks of intervention, compared with follow-up of 8 weeks after the end of the score, the difference was not statistically significant (P0.05). (2) patients in the control group in the muscle, shoulder joint, elbow joint, wrist joint (flexion) joint activity, motor function, activities the daily life ability score in intervention Before and after 4 weeks of intervention, the follow-up period was 8 weeks after the end of comparison, the difference was statistically significant (P0.05), the rest were not statistically significant (P0.05). (3) before the intervention group and the control group of patients had different symptoms of constipation, hand micro vibration nursing intervention, the experimental group there were no symptoms of constipation, 17 cases in the control group (43.6%). Two groups of patients with symptoms of constipation constipation were compared, the difference was statistically significant (2=20.775, P0.05).3. experimental group and control group in each index: (1) comparison of muscle strength and muscle tension scores of the experimental group and control group before intervention, after 4 weeks of intervention, comparison of follow-up end strength score after 8 weeks before the intervention, no significant difference after 4 weeks of intervention, the follow-up period was 8 weeks after the end of the comparison of strength, the difference was statistically significant (P0.05), the experimental group than the control group improved muscle force experiment is better. And the control group Group before intervention, after 4 weeks of intervention, comparison of follow-up end muscle tension scores after 8 weeks, in addition to differences in the follow-up period of 8 weeks after the end of the left upper limb muscle tension and right lower limb muscle tension scores was statistically significant (P0.05), the rest were not statistically significant (P0.05). No obvious the difference in muscle tension changes in experimental group and control group. (2) the shoulder joint, elbow joint, wrist joint activity score comparison: the experimental group and the control group of patients before intervention, after 4 weeks of intervention, the follow-up period end compare joint activity score after 8 weeks, in addition to the end of the 8 week follow-up period after the shoulder joint (flexion, abduction) there was a significant difference between the joint activity (P0.05), the rest were not statistically significant (P0.05). The experimental group and the control group in the patients with shoulder joint, elbow joint, wrist movement change is not obvious. (3) of hip joint, knee joint. The ankle joint. 鍔ㄥ害寰楀垎鐨勬瘮杈，

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